Midterm Check your Understanding
Which type of leukemia primarily affects children?
ALL (acute lymphoid leukemia)
In general, the best prognosis for long-term disease-free survival occurs with
ALL (acute lymphoid leukemia).
An elderly patient's blood pressure is measured at 160/98. How would the patient's left ventricular function be affected by this level of blood pressure?
Left ventricular workload is increased with high afterload.
Massive release of histamine with consequent vasodilation and hypotension occurs with what type of shock?
Anaphylactic
What results when systemic blood pressure is increased?
Vasoconstriction
A patient with a productive cough and parenchymal infiltrates on x-ray is demonstrating symptomology of
bacterial pneumonia.
Tachycardia is an early sign of low cardiac output that occurs because of
baroreceptor activity.
Excessive red cell lysis can be detected by measuring the serum
bilirubin.
Paraneoplastic syndromes in cancer involve excessive production of substances by multiple means. A common substance found in excessive amounts resulting from cancer paraneoplastic syndromes is
calcium.
Low cardiac output in association with high preload is characteristic of ________ shock.
cardiogenic
Velocity of blood flow is measured in
centimeters per second.
A cause of thrombocytopenia includes
chemotherapy
Your patient eats "lots of fat," leads a "stressful" life, and has smoked "about two packs a day for the last 40 years." Her chronic morning cough recently worsened, and she was diagnosed with a lung mass. The most likely contributing factor for development of lung cancer in this patient is
cigarette smoking.
The final step in clot formation is
clot retraction.
Patent ductus arteriosus is accurately described as a(n)
communication between the aorta and the pulmonary artery.
When a patient is struck in the eye by a baseball, the result is redness and swelling. This increase in blood flow to a localized area is called
hyperemia.
Risk factors for atherosclerosis include
hyperlipidemia
Venous obstruction leads to edema because it ________ pressure.
increases capillary hydrostatic
Empyema is defined as an
infection in the pleural space.
Disseminated intravascular coagulation may be treated with heparin therapy to
inhibit clotting factor consumption.
Clinical manifestations of chronic arterial obstruction include
intermittent claudication.
Coagulative necrosis is caused by
interrupted blood supply.
Pernicious anemia is caused by a lack of
intrinsic factor.
Reperfusion injury to cells
involves formation of free radicals.
The primary source of erythropoietin is provided by the
kidney.
Critically ill patients may have parenterally administered vasoactive drugs that are adjusted according to their _____ pressure.
mean arterial
A 17-year-old college-bound student receives a vaccine against an organism that causes meningitis. This is an example of
primary prevention.
A patient with metastatic lung cancer wants to know her chances for survival. Which response is correct?
"Lung cancer has about a 15% survival rate."
The arterial oxygen content (CaO2) for a patient with PaO2 100 mm Hg, SaO2 95%, and hemoglobin 15 g/dL is _____ mL oxygen/dL.
19.4
A patient presents to the physician's office with pinpoint hemorrhages on the skin. The patient is most likely between the ages of _____ years.
4 and 7
In which dysrhythmias should treatment be instituted immediately?
Atrial fibrillation with a ventricular rate of 220 beats/minute
The therapy that most directly improves cardiac contractility in a patient with systolic heart failure is
digitalis.
A middle-aged patient has a follow up visit for a recorded blood pressure of 162/96 mm Hg taken 3 weeks ago. The patient has no significant past medical history and takes no medications, but smokes 1 1/2 packs of cigarettes per day, drinks alcohol regularly, and exercises infrequently. The patient is about 40 lbs. overweight and admits to a high-fat, high-calorie diet. At the office visit today, the patient's blood pressure is 150/92 mm Hg. What is the least appropriate intervention for this patient at this time?
Begin antihypertensive drug therapy.
Retroviruses are associated with human cancers, including
Burkitt lymphoma.
How do clinical conditions that increase vascular permeability cause edema?
By allowing plasma proteins to leak into the interstitial fluid, which draws in excess fluid by increasing the interstitial fluid osmotic pressure
Increased preload of the cardiac chambers may lead to which patient symptom?
Edema
What is the correct definition of complete remission (CR) of leukemia?
CR is less than 5% blasts in marrow and normal CBC values.
Patients with structural evidence of heart failure who exhibit no signs or symptoms are classified into which New York Heart Association heart failure class?
Class I
In which stage of shock is a patient who has lost 1200 mL of blood, who has normal blood pressure when supine, but who experiences orthostatic hypotension upon standing?
Class II, Compensated Stage
Angina caused by coronary artery spasm is called _____ angina.
Prinzmetal variant
Administration of which therapy is most appropriate for hypovolemic shock?
Crystalloids
Which clinical manifestation is not likely the result of a tuberculosis infection?
Cyanosis
The cellular component that is most susceptible to radiation injury is the
DNA.
Which alterations can lead to edema?
Decreased lymphatic flow
Hyperaldosteronism causes
ECV excess and hypokalemia.
Burkitt lymphoma is most closely associated with
Epstein-Barr virus.
A patient is diagnosed with cardiogenic shock. The patient is hyperventilating and is therefore at risk for the respiratory complication of respiratory acidosis.
False
A type of shock that includes brain trauma that results in depression of the vasomotor center is cardiogenic.
False
In general, a cancer cell that is more tissue-specific differentiated is more likely to be aggressive.
False
Seasonal allergic rhinitis is most involved in type II hypersensitivity reactions.
False
Vaccination for pneumococcal pneumonia should be performed before 1 year of age in patients with sickle cell anemia.
False
What is likely to lead to hyponatremia?
Frequent nasogastric tube irrigation with water
The characteristic x-ray findings in tuberculosis include
Ghon tubercles.
The effects of histamine release include
increased vascular permeability.
A patient who reports an intestinal fistula also reports feeling "weak and dizzy" when she stands. While taking her blood pressure she becomes temporarily unresponsive but quickly regains consciousness when put into a supine position. What nursing interventions will the nurse implement before calling the physician?
Give her water or juice and some salty crackers and ask if she has had any diarrhea or vomiting.
Which disorder is considered a primary immunodeficiency disease?
HIV/AIDS
Which electrolyte imbalances cause increased neuromuscular excitability?
Hypocalcemia and hypomagnesemia
A child with a history of recent strep throat infection develops glomerulonephritis. This is most likely a type _____ hypersensitivity reaction.
III
The principle Ig mediator of type I hypersensitivity reactions is
IgE
When exposed to inhaled allergens, a patient with asthma produces large quantities of
IgE.
What is the most likely explanation for a diagnosis of hypernatremia in an elderly patient receiving tube feeding?
Inadequate water intake
While hospitalized, an elderly patient with a history of myocardial infarction was noted to have high levels of low-density lipoproteins (LDLs). What is the significance of this finding?
Increased LDL levels are associated with increased risk of coronary artery disease.
In individuals who have asthma, exposure to an allergen to which they are sensitized leads to which pathophysiologic event?
Inflammation, mucosal edema, and bronchoconstriction
Which is not normally secreted in response to stress?
Insulin
Your patient is scheduled for a staging procedure. She wants to know what that means. The correct response is which of the following?
It is a procedure for determining the extent of tumor spread.
Which characteristic is indicative of hemolytic anemia?
Jaundice
A patient has been exposed to meningococcal meningitis, but is not yet demonstrating signs of this disease. This stage of illness is called the _____ stage.
Latent
Dysfunction of which organ would lead to clotting factor deficiency?
Liver
Diarrhea causes
Metabolic Acidosis because its from the (ass)
Familial retinoblastoma involves the transmission of what from parent to offspring?
Mutant tumor-suppressor gene
The organism that causes pulmonary tuberculosis is
Mycobacterium tuberculosis.
Renal insufficiency is a common complication of which disease?
Myeloma
Which assessment would support a diagnosis of type A COPD rather than type B COPD
Normal PaCO2, scant sputum, accessory muscle use, barrel chest
Which group of clinical findings describes the typical presentation of ALL (acute lymphoid leukemia)?
Pain in long bones, infection, fever, bruising
Which dysrhythmia is thought to be associated with reentrant mechanisms?
Preexcitation syndrome tachycardia (Wolf-Parkinson-White syndrome)
Which is not a manifestation of acute arterial obstruction?
Purpura
The most reliable indicator that a person is experiencing an acute myocardial infarction (MI) is
ST-segment elevation.
What form of oral rehydration, bottled water or salty broth, is best suited for a patient who is demonstrating signs of clinical dehydration?
Salty soup, because it will provide some sodium to help hold the fluid in his blood vessels and interstitial fluid
A patient presenting with fever, hypotension, and lactic acidosis is most likely to be experiencing what type of shock?
Septic
Overproduction of nitric oxide is an important aspect of the pathophysiologic process of what type of shock?
Septic
Which finding is indicative of orthostatic hypotension in a person with a supine blood pressure (BP) of 110/70 and a heart rate (HR) of 100?
Sitting BP 88/60, HR 118
The majority of tachydysrhythmias are believed to occur because of
reentry mechanisms.
Which complication of asthma is life threatening?
Status asthmaticus
Which disorder is associated with a type III hypersensitivity mechanism of injury?
Systemic lupus erythematosus
The assessment findings of a 5-year-old with a history of asthma include extreme shortness of breath, nasal flaring, coughing, pulsus paradoxus, and use of accessory respiratory muscles. There is no wheezing and the chest is silent in many areas. How should you interpret your assessment?
The child may be having such a severe asthma episode that the airways are closed, so start oxygen and get the doctor immediately.
Which vessel normally demonstrates the most rapid blood flow?
The vena cava
Disseminated intravascular coagulation is a serious complication of septic shock characterized by abnormal clot formation in the microvasculature throughout the body.
True
Hemophilia B is also known as Christmas disease.
True
Lactated Ringer solution and normal saline are commonly used crystalloid solutions that contain electrolytes.
True
The anemia resulting from a deficiency of either vitamin B12 (cobalamin) or folate is caused by a disruption in DNA synthesis of the blast cells in the bone marrow that produces very large abnormal bone marrow cells called megaloblasts.
True
The ingestion of certain drugs, foods, or chemicals can lead to secondary hypertension.
True
The liver is responsible for the synthesis of coagulation factors, with the exception of part of VIII.
True
Two of the most serious oncology emergencies associated with non-Hodgkin lymphoma are obstruction of the superior vena cava and compression of the spinal cord.
True
Croup is characterized by
a barking cough.
Viral pneumonia is characterized by
a dry cough.
Mitral stenosis is associated with
a pressure gradient across the mitral valve.
Which serum biomarker(s) are indicative of irreversible damage to myocardial cells?
a) Elevated CK-MB, troponin I, and troponin T
Bacterial pneumonia leads to hypoxemia caused by
accumulation of alveolar exudates.
While in the hospital for management of acute lymphoid leukemia (ALL), a patient develops severe thrombocytopenia. The most appropriate action for this condition is
activity restriction.
COPD leads to a barrel chest, because it causes
air trapping.
All the following stress-induced hormones increase blood glucose except
aldosterone.
Selye's three phases of the stress response include all the following except
allostasis
The majority of cases of anaphylactic shock occur when a sensitized individual comes in contact with
antibiotics
Proto-oncogenes
are normal cellular genes that promote growth.
A commonly ingested substance associated with prolongation of the bleeding time is
aspirin.
Effects of hypernatremia on the central nervous system typically include
confusion
Apoptosis is a process that results in cellular
death.
Hypernatremia may be caused by
decreased antidiuretic hormone secretion.
Total body water in older adults is
decreased because of increased adipose tissue and decreased muscle mass.
Extreme cold injures cells by all the following except
decreased blood viscosity.
The primary effect of aging on all body systems is
decreased functional reserve.
Excessive antidiuretic hormone (ADH) secretion can cause _____ concentration.
decreased serum sodium
When systemic vascular resistance is decreased, blood flow
decreases.
Primary treatment for myocardial infarction (MI) is directed at
decreasing myocardial oxygen demands.
Clinical manifestations of severe symptomatic hypophosphatemia are caused by
deficiency of ATP.
Of the statements below, the accurate statement regarding nutrition and cellular health is
deficient cellular uptake by one cell type may contribute to excess nutrient delivery to other cell types.
Aortic regurgitation is associated with
diastolic murmur.
Widespread activation of the clotting cascade secondary to massive trauma is called
disseminated intravascular coagulation (DIC).
A common characteristic of viral pneumonia is
dry cough.
Renal compensation for respiratory acidosis is evidenced by
elevated bicarbonate ion concentration.
A laboratory test finding helpful in confirming the diagnosis of iron-deficiency anemia is
elevated total iron-binding capacity.
A disease that is native to a particular region is called
endemic
Treatment for hemophilia A includes
factor VIII replacement.
The conversion of plasminogen to plasmin results in
fibrinolysis
Pneumocystitis is a term that refers to a
fungal pneumonia secondary to HIV.
Red blood cells obtain nearly all their energy from metabolism of
glucose.
The nurse provides teaching regarding dietary intake of potassium to avoid an electrolyte imbalance when a patient
has chronic heart failure that is treated with diuretics.
The patient who requires the most careful monitoring for development of metabolic acidosis is a patient who
has had diarrhea for over a week.
Early manifestations of a developing metabolic acidosis include
headache
A 3-year-old boy who exhibits prolonged bleeding after minor trauma and a prolonged aPTT, but a normal platelet count, is likely to be diagnosed with
hemophilia
Decreased neuromuscular excitability is often the result of
hypercalcemia and hypermagnesemia.
An increase in organ size and function caused by increased workload is termed
hypertrophy
Respiratory alkalosis is caused by
hyperventilation (early high altitude exposure), aspirin ingestion (early)
Metabolic alkalosis is often accompanied by
hypokalemia
A person who overuses magnesium-aluminum antacids for a long period of time is likely to develop
hypophosphatemia
Abnormalities in intracellular regulation of enzyme activity and cellular production of ATP are associated with
hypophosphatemia.
Respiratory acidosis may be caused by
hypoventilation.
The body compensates for metabolic alkalosis by
hypoventilation.
To best prevent emphysema, a patient is instructed to stop smoking since cigarette smoke
impairs α1-antitrypsin, allowing elastase to predominate.
A patient has a positive Chvostek sign. The nurse interprets this as a sign of
increased neuromuscular excitability.
Chronic bronchitis often leads to cor pulmonale because of
increased pulmonary vascular resistance.
The increased anterior-posterior chest diameter associated with obstructive lung disease is caused by
increased residual lung volumes.
Diarrhea and other lower intestinal fluid losses will contribute to
metabolic acidosis.
Thalassemia may be confused with iron-deficiency anemia, because they are both
microcytic
A loud pansystolic murmur that radiates to the axilla is most likely a result of
mitral regurgitation.
Two primary acid-base disorders that are present independently are referred to as
mixed acid-base imbalance.
Clinical manifestations of moderate to severe hypokalemia include
muscle weakness and cardiac dysrhythmias.
A 58-year-old woman is seen in the clinic for reports of severe back pain. Her chest x-ray demonstrates generalized bone demineralization and compression fracture. Blood studies demonstrate elevated calcium levels. The most likely diagnosis is
myeloma.
All these cellular responses are potentially reversible except
necrosis.
Tumor necrosis factor α and interleukin-1 contribute to shock states because they induce production of
nitric oxide.
A major cause of treatment failure in tuberculosis is
noncompliance.
A person who experiences a panic attack and develops hyperventilation symptoms may experience
numbness and tingling in the extremities.
Asthma is categorized as a(n)
obstructive pulmonary disorder.
Hypertension is closely linked to
obstructive sleep apnea.
Breast cancer in women who have the breast cancer gene
occurs at an earlier age.
A patient with flail chest will demonstrate
outward chest movement on expiration.
The strength of the bond between oxygen and hemoglobin is known as the
oxygen-hemoglobin affinity.
Fully compensated respiratory acidosis is demonstrated by
pH 7.36, PaCO2 55, HCO3- 36.
A patient has been hospitalized several times in 6 months with severe ECV depletion and hypokalemia resulting from chronic laxative abuse. Which blood gas results should be relayed to the physician?
pH in high part of normal range, PaO2 normal, PaCO2 high, bicarbonate high
Hypotension associated with neurogenic and anaphylactic shock is because of
peripheral pooling of blood.
A deficiency of von Willebrand factor impairs
platelet adhesion to injured tissue.
The megakaryocyte is a precursor to
platelets.
Accumulation of fluid in the pleural space is called
pleural effusion.
A patient exhibiting respiratory distress as well as a tracheal shift should be evaluated for
pneumothorax.
An abnormally wide (more than 0.10 second) QRS complex is characteristic of
premature ventricular complexes.
Legionnaires disease is characterized by
presence of systemic illness.
Left-sided heart failure is characterized by
pulmonary congestion.
A serious complication of deep vein thrombosis is
pulmonary embolus.
Indicators that an individual is experiencing high stress include all the following except
pupil constriction.
When preparing for the admission of a client diagnosed with bronchiectasis, the nurse will
put a sputum cup and a box of tissues on the bedside table.
The person at highest risk for developing hypernatremia is a person who
receives tube feedings because he or she is comatose after a stroke.
Transfusion reactions involve RBC destruction caused by
recipient antibodies.
The hypersecretion of mucus resulting for chronic bronchitis is the result of
recurrent infection.
The common denominator in all forms of heart failure is
reduced cardiac output.
Low cardiac output to the kidneys stimulates the release of _____ from juxtaglomerular cells.
renin
The ________ system compensates for metabolic acidosis and alkalosis.
respiratory
The arterial blood gas pH = 7.52, PaCO2 = 30 mm Hg, HCO3- = 24 mEq/L demonstrates
respiratory alkalosis.
Atherosclerotic plaques with large lipid cores are prone to
rupture.
Hypertension with a specific, identifiable cause is known as _____ hypertension.
secondary
The most common primary immune deficiency that affects only B cells is
selective IgA.
A patient with cold and edematous extremities, low cardiac output, and profound hypotension is likely to be experiencing a progressive stage of ________ shock.
septic
A laboratory test that should be routinely monitored in patients receiving digitalis therapy is
serum potassium.
An increase in hemoglobin affinity for oxygen occurs with
shift to the left.
The electrolyte that has a higher concentration in the extracellular fluid than in the intracellular fluid is _____ ions.
sodium
The most definitive diagnostic method for active tuberculosis is acquired via
sputum culture.
A patient with a history of myocardial infarction continues to complain of intermittent chest pain brought on by exertion and relieved by rest. The likely cause of this pain is
stable angina.
Autologous stem cell transplantation is a procedure in which
stem cells are harvested from the patient and then returned to the same patient.
C.Q. was recently exposed to group A hemolytic Streptococcus and subsequently developed a pharyngeal infection. His clinic examination reveals an oral temperature of 102.3°F, skin rash, dysphagia, and reddened throat mucosa with multiple pustules. He complains of sore throat, malaise, and joint stiffness. A throat culture is positive for Streptococcus, and antibiotics have been prescribed. The etiology of C.Q.'s disease is
streptococcal infection.
The stage during which the patient functions normally, although the disease processes are well established, is referred to as
subclinical.
A patient with significant aortic stenosis is likely to experience
syncope
Pulse pressure is defined as
systolic pressure - diastolic pressure.
The progressive stage of hypovolemic shock is characterized by
tachycardia.
A patient is diagnosed with a tortuous blood vessel of the right hand that bleeds spontaneously. This patient presents with
telangiectasia.
Air that enters the pleural space during inspiration but is unable to exit during expiration creates a condition called
tension pneumothorax.
After suffering a heart attack, a middle-aged man is counseled to take a cholesterol-lowering medication. This is an example of
tertiary prevention.
Blood flow throughout the periphery is regulated by
the autonomic nervous system.
The activated partial thromboplastin time (aPTT) is a measure of the integrity of
the intrinsic pathway.
Allostasis is best defined as
the overall process of adaptive change necessary to maintain survival and well-being.
Airway obstruction in chronic bronchitis is because of
thick mucus, fibrosis, and smooth muscle hypertrophy.
Causes of metabolic acidosis include
tissue anoxia.
Activation of the extrinsic pathway of coagulation is initiated by
tissue thromboplastin.
The hypermetabolic state leading to cachexia in terminal cancer is thought to be because of
tumor necrosis factor.
The effect of nitric oxide on systemic arterioles is
vasodilation.
Osmoreceptors located in the hypothalamus control the release of
vasopressin (antidiuretic hormone, ADH).
An example of an acyanotic heart defect is
ventricular septal defect.
A normal bleeding time in association with normal platelet count, and increased prothrombin time (PT) and INR, is indicative of
vitamin K deficiency.
Rheumatic heart disease is most often a consequence of
β-hemolytic streptococcal infection.
High blood pressure increases the workload of the left ventricle, because it increases
afterload.
The inward-pulling force of particles in the vascular fluid is called _____ pressure.
capillary osmotic
Cancer grading is based on
cell differentiation.
Manifestations from sodium imbalances occur primarily as a result of
cellular fluid shifts.
A patient, who is 8 months pregnant, has developed eclampsia and is receiving intravenous magnesium sulfate to prevent seizures. To determine if her infusion rate is too high, you should regularly
check the patellar reflex; if it becomes weak or absent, her infusion rate probably is too high and she is at risk for respiratory depression or cardiac arrest.
A known cause of hypokalemia is
insulin overdose.
The cellular response indicative of injury because of faulty metabolism is
intracellular accumulations.
The primary cause of infant respiratory distress syndrome is
lack of surfactant.
First-degree heart block is characterized by
prolonged PR interval.